Recurrent Dislocation of patella -PAWAN

ORTHOPAEDICS

1. PATELLAPATELLA
RECURRENT RECURRENT
DISLOCATIONDISLOCATION
DR. PAWAN K. YADAV
D.ORTHO.,DNB(ORTHO)
BIRRD HOSPITAL, TIRUPATHI

2. RECURRENT DISLOCATION
•When the patella shifts laterally with minimal stress on flexion of
knee,..

3. ANATOMY - Q ANGLE

4. PREDISPOSING CAUSES
•Increased Q angle
•Weakness and laxity of medial quads.
•Tight lateral structures.
•Abnormal insertion of lig. Patella. ( lateral)
•Defective development of lat. Femoral condyle
and flattening of intercondylar groove.
•Maldevelopment of patella.(alta/baja)
•Valgus deformity of knee.

5. CLINICAL FEATURES
•Girls > boys
•Bilateral
•Acute pain & knee stuck in flexion, falls to ground.
•Tenderness medial side of knee.
•Swollen joints- later
•Aspiration- haemarthrosis

6. •Apprehension test(provocative): positive
•A positive J sign—slight lateral subluxation of
the patella as the knee approaches full
extension
•X ray- AP/Lat/ Skyline
•Blumensaat line
•Sulcus angle
•Q angle
•Insall’ s index

7. APPREHENSION TEST(PROVOCATIVE):

8. X RAY - SKYLINE VIEW

9. BLUMENSAAT LINE

10. SULCUS ANGLE
& CONGRUENCE ANGLE
•Angle MSL is the sulcus angle
•Angle PSO is the congruence
angle

11. INSALL’ S INDEX

12. TREATMENT.
•Conservative:
Once reduced, immobilize for 3
weeks, start quads & vmo

13. Surgical Mx:
Release tight structures
Tighten loose structures
Realignment of extensor mechanism.

14. SURGICAL-CONTD………
1.Suprapatellar realignment (campbell’s).
2.Infrapatellar realignment (Gold-twait).
3.Infrapatellar bony realignment ( Hauser).
4.Patellectomy (Soto-hall).

15. SUPRAPATELLAR
REALIGNMENT (CAMPBELL’SCAMPBELL’S).

16. INFRAPATELLAR REALIGNMENT
(GOLD-TWAIT).

17. INFRAPATELLAR BONY REALIGNMENT
(HAUSER)

18. PATELLECTOMY (SOTO-HALL).

19. COMPLICATIONS
• Instabilty of knee.
• Loose bodies due to osteochondral #
• Osteoarthritis- secondary
• Postsurgical
1.Infection
2.stiffness

20. OTHER TYPES
•Congenital dislocation: from birth due to
tight lateral structures. Very rare. Poor
results.
•Habitual dislocation: patella dislocates
every time there is flexion and reduces on
extension.

21. [email protected]